Merry Christmas & a Present for Me

Fervent wishes for a very Merry Christmas to my family and friends, and to the others who visit the blog.

If you celebrate other holidays instead of or in addition to Christmas,  I hope that you enjoy them very much.

May the season be very happy and healthy for you in any case, and may the coming new year be much better than any that preceded it.

May peace and good will prevail throughout the world, and the sooner the better!

Earlier today, a small foray intended to practice driving in the parking lot of a nearby supermarket worked out so well that I was able to just drive away and--smoothly and without incident, but not without a certain amount of trepidation--head over to the main post office and return home. 

Learning that the confidence I felt in driving, after nearly two years, and with half or so of that bed-ridden, was in fact not misplaced, was a very welcome Christmas present for me.

I hope that all of you get for Christmas whatever gift you most desire, and that you have a very happy holiday season.

It Takes Nerve

Looking over some older posts, and reviewing some email messages I’ve sent to friends and family members, I notice that I’ve been describing the condition that was (mostly) responsible for my long hospitalization as “myelitis”. That’s true enough and simple enough, but it’s also somewhat as if I had said I had a fever, sore throat, and breathing problems when in fact I had influenza.

Strictly speaking, the spinal cord condition that caused me so much trouble was a “spinal dural arteriovenous fistula”, which the medical folks seem to refer to as “SDAVF”. It seems to be a fairly rare condition, and from what I’ve read it appears that I was fortunate that it affected my spinal cord rather than my brain.

I was definitely fortunate that it was discovered and diagnosed fairly early, and that I had excellent medical care in top-notch facilities.

Since being released from the last of the three hospitals and concentrating on rehabilitation, I’ve been concerned about how soon—and how much—I’m likely to recover. I am of course hoping and striving for a full recovery that has me eventually in better-than-ever condition, but I’ve never been so optimistic that I could ignore reality. For a while it didn’t look as if my legs and feet were ever going to follow my brain’s orders properly. Lately, however, my recovery has been accelerating, with nerves and muscles cooperating rather well.

Dr. Nishida, the doctor whom I’ve been visiting for a couple of decades now for everything from colds to sprains, and who is now making monthly house calls to check on me, runs his own clinic as a GP these days, but was originally a specialist neurosurgeon/brain surgeon. He tells me that although the nerves connecting spinal cord to limbs readily regenerate it’s very unlikely that spinal cord nerve cells had died and are now regenerating. Instead, it’s rather as if some of them had been temporarily “asleep” and are now gradually awakening.

Whatever the nerve details may be, I’m very pleased to see returning function and almost daily expansion of my range of physical activity. Less than a year ago, I could barely stand up. A couple of days ago, I was practicing precise control of my foot and ankle as I maneuvered my car around my yard. It did take some courage to fire up the engine and hit the gas pedal for the first time in nearly two years, since it requires a light and careful touch to avoid sudden and very dramatic acceleration, and many people would be annoyed if I were to embed the car in my house, but in fact it went very smoothly.

Sometimes it takes nerve, sometimes it takes nerves, sometimes it takes both.

Drive

By this coming spring or summer, it’s quite possible that I may once again be driving…before I’ve entirely recovered my ability to walk properly. That’s not too odd, since driving has been an important part of my life for a very long time, whether cars, motorbikes, or trucks; I even drove a forklift for a while, back when I was 18 or so.

My driver’s license comes up for renewal within a month either side of my birthday at the end of March. Before I can get it renewed, I have to pass the recently-mandated senior drivers’ evaluation. This involves going to a nearby driving school, listening to a safety lecture, passing a vision test, and doing a 10-minute practical driving session with an instructor/evaluator.

The requirement for evaluating older drivers’ physical and mental condition was prompted by numerous high-profile traffic accidents involving seniors, including fairly numerous incidents—sometimes resulting in tragedy--of hitting the accelerator instead of the brake, and a few highly publicized cases of older drivers going the wrong way on expressways.

Driving the wrong way on an expressway is something of a feat, actually: virtually all exits have toll booths that should severely impede if not prevent entry, and entering the roadway from service/parking areas in the wrong direction is not something done out of merely slight confusion.

I haven’t reached that level of confusion yet, and my reflexes are still quite good. My judgement is as good as it ever was…I’ll wait until the laughter dies down on that last one.

I am, however, still recuperating and rehabilitating from being mostly bed-ridden for nearly a year. This time last year, I could barely stand up even with assistance. These days my mobility has improved greatly, but I’m still not able, while seated, to raise my right leg as high, or move it as quickly, as I would like. This worried me when I got the notice about appearing for the senior driving evaluation: I cannot pick up and move that right foot from the gas to the brake and back fast enough to make driving feasible. Not yet, anyway.

So, while my and the therapists’ and other rehab-related folks’ efforts are aimed at returning me to full mobility—or as close to it as possible—the immediate focus is on devising a strategy and tactics for making driving practical (and safe, of course). With the cooperation of my house-call therapist I’ve discovered that swiveling my foot at the heel is quite sufficient to deal with the gas and brake pedals on his kei-sized company car, and—since he very kindly drove his personal vehicle the other day so that I could try it—on a Toyota Voxy, as well. This swiveling motion, somewhat as in “heel & toe shifting”, is fine as long as the pedals aren’t too far apart, or too different in height from the floorboard. Using the walker when entering and exiting the car works pretty smoothly, too.

Next week, I’ll be trying out my own car, despite not being too sanguine about my chances. Shimada-san, my friend the mechanic, who has for many years been selling us used and new cars and bikes, and insurance, and along with his brother fixing our vehicles, too, has been taking care of my car since I entered the hospital. He went down to Tokyo to pick it up from the parking lot where I’d left it when I broke my leg and started my long hospital stay, and he’s been keeping it safe and starting it once in a while until I’m ready to drive it again. The car, a 2014 Suzuki Escudo, is an AWD compact SUV, and while its legroom is a plus, its height from the ground may prove a bit challenging for entry and egress. The gas and brake pedal configuration may cause some difficulty, too. We’ll see what happens next week.

Whether it’s in my own car or a rented or borrowed one, there is a fairly strong possibility that I may soon end up being able to drive quite competently and safely while still needing a walker (or maybe a cane, depending on near-future rehab progress). If so, it will be thanks to the efforts of the very dedicated PTs and my other valued supporters, and of course partly due to my own determination. Or my, well…drive.

Stepping Up

 It has been a little over 14 months since I was—finally--released from the hospital after a seven-month-long stay spread across three institutions in Tokyo. About a month after that, I started rehabilitation at a hospital-connected day care/rehab facility near my house.

At first, I was essentially unable to stand up unaided, and the apex of my physical accomplishment was an increased facility in transferring from wheelchair to bed and back. For a long time my legs hadn’t been able to obey my brain’s commands, and the lengthy hospital stay had led to significant muscle atrophy to go along with the spinal nerve issues. The very dedicated and professional physical and occupational therapists (PTs and OTs) had done their best, including arranging to borrow some specialized equipment to help start me walking again, but the conditions weren’t ideal and when I left the hospital I had a long way still to go.

The very able supervision and assistance of an extremely capable care manager--an ex-nurse who managed to be simultaneously compassionate, competent, friendly, and incisive—made all sorts of arrangements for renting equipment such as wheelchair, lift, etc., for selecting and scheduling home helper and nurses, and for securing transportation infinitely easier. Her help with navigating the complicated paperwork involved in welfare, insurance, and tax issues was absolutely invaluable. She has recently taken a leave of absence, and has been replaced by another lady who has so far also been quite helpful and kind.

Since leaving the hospital and returning home, I’ve been spending about three days a week at the day care/rehab place, working my way through various exercises with the help of a new set of hard-working, friendly therapists, nurses, and support staff, using a succession of equipment.

I’ve come up from barely capable of standing up from my wheelchair at the parallel bars, to striding along pretty smoothly with the aid of a “pickup walker” (i.e., one without wheels, that you pick up and set down ahead of yourself as you walk along).

For the last couple of months I’ve been fortunate to have another PT making weekly visits to my home, to help with tactics and tricks for specific functions such as cooking, showering, and the like in that more straitened environment.

While broadly aiming at increasing strength and restoring mobility overall, the current therapy focus is on climbing and descending steps and dealing with slopes and uneven surfaces. Walking smoothly on flat flooring is one thing, but my study is raised 15 cm from the next room, and climbing up that step was essential to being able to use Barghest, my desktop PC, and to accessing the books with which my study is lined floor to ceiling. Then there's the genkan, which as with most Japanese houses requires stepping up into the house from outside. My yard is far from even-surfaced. There’s my car, too, an SUV with a floorboard fairly high off the ground, but that’s a topic for another post.

So far, I’ve finally been successful in accessing my study—I now spend a major portion of my waking hours there--and have become progressively smoother getting into and out of the house through the genkan. Climbing steps is an important milestone along my mobility journey, and I’ve been stepping up to it with a will.